OBJECTIVES:We performed a meta-analysis of prognostic studies of patients with a Brugada ECG to assess predictors of events. BACKGROUND:The Brugada syndrome is an increasingly recognized cause of idiopathic ventricular fibrillation; however, there is wide variation in the prognosis of patients with the Brugada ECG. METHODS AND RESULTS:We retrieved 30 prospective studies of patients with the Brugada ECG, accumulating data on 1,545 patients. Summary estimates of the relative risk (RR) of events (sudden cardiac death [SCD], syncope, or internal defibrillator shock) for a variety of potential predictors were made using a random-effects model. The overall event rate at an average of 32 months follow-up was 10.0% (95% CI 8.5%, 11.5%). The RR of an event was increased (P < 0.001) among patients with a history of syncope or SCD (RR 3.24 [95% CI 2.13, 4.93]), men compared with women (RR 3.47 [95% CI 1.58, 7.63]), and patients with a spontaneous compared with sodium-channel blocker induced Type I Brugada ECG (RR 4.65 [95% CI 2.25, 9.58]). The RR of events was not significantly increased in patients with a family history of SCD (P = 0.97) or a mutation of the SCN5A gene (P = 0.18). The RR of events was also not significantly increased in patients inducible compared with noninducible by electrophysiologic study (EPS) (RR 1.88 [95% CI 0.62, 5.73], P = 0.27); however, there was significant heterogeneity of the studies included. CONCLUSIONS:Our findings suggest that a history of syncope or SCD, the presence of a spontaneous Type I Brugada ECG, and male gender predict a more malignant natural history. Our findings do not support the use of a family history of SCD, the presence of an SCN5A gene mutation, or EPS to guide the management of patients with a Brugada ECG.

译文

目的:我们对Brugada ECG患者的预后研究进行了荟萃分析,以评估事件的预测因素。
背景:Brugada综合征是越来越多的公认的特发性室颤的病因。但是,Brugada ECG患者的预后差异很大。
方法和结果:我们检索了30例Brugada心电图患者的前瞻性研究,积累了1,545例患者的数据。使用随机效应模型对各种潜在预测因素的事件(突发性心源性死亡[SCD],晕厥或内部除颤器电击)的相对风险(RR)进行了简要估算。平均随访32个月的总事件发生率为10.0%(95%CI 8.5%,11.5%)。有晕厥或SCD病史的患者中,事件的RR增加(P <0.001)(RR 3.24 [95%CI 2.13,4.93]),男性比女性(RR 3.47 [95%CI 1.58,7.63]) ,以及自发性与钠通道阻滞剂诱导的I型Brugada ECG相比的患者(RR 4.65 [95%CI 2.25,9.58])。有SCD家族史(P = 0.97)或SCN5A基因突变(P = 0.18)的患者,事件的RR并未显着增加。通过电生理研究(EPS),可诱导的患者的事件的RR也未明显高于未诱导的患者(RR 1.88 [95%CI 0.62,5.73],P = 0.27);但是,所包括的研究存在明显的异质性。
结论:我们的发现提示晕厥或SCD的病史,自发的I型Brugada ECG的存在以及男性都预示着更恶性的自然病史。我们的发现不支持使用SCD家族史,存在SCN5A基因突变或EPS来指导Brugada ECG患者的治疗。

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